Preparing for and Preventing Bioterrorism: Strengthening the U.S. Public Health Infrastructure Is the Key to Enhancing the Nation's Safety. (Perspectives)

Hamburg, Margaret A., Issues in Science and Technology

The tragic events of September 11th, followed by the recent anthrax incidents, have made us painfully aware of our nation's vulnerability to terrorism, including bioterrorism. Although once considered a remote concern, the possibility that a biological agent might be intentionally used to cause widespread panic, disease, and death is now a common concern. Whether the event involves an unsophisticated delivery system with a limited number of true cases, as we have seen with the current anthrax scare, or a carefully orchestrated attack with mass casualties, the prospects are frightening. As the United States mobilizes to address an array of overlapping foreign policy, infectious disease, and national security threats, it must make sure that a comprehensive program to counter and prevent bioterrorism ranks high on the priority list.

The threat of bioterrorism is fundamentally different from other threats we face, such as conventional explosives or even a chemical or nuclear weapon. By its very nature, the bioweapons threat, with its close links to naturally occurring infectious agents and disease, requires a different strategy. Meaningful progress against this threat depends on understanding it in the context of epidemic disease. It requires different investments and different partners. Without this recognition, the nation's preparedness programs will be inadequate, and we may miss critical opportunities to prevent such an attack from occurring in the first place.

Biological terrorism is not a "lights and sirens" kind of attack. Unless the release is announced or fortuitous discovery occurs early on, there will be no discrete event to signal that an attack has happened, and no site that can be cordoned off while authorities take care of the casualties, search for clues, and eventually clean up and repair the damage. Instead, a bioterrorism event would most likely unfold as a disease epidemic, spread out in time and place before authorities even recognize that an attack has occurred. Recognition that an attack had occurred would emerge only when people began appearing in their doctor's office or an emergency room with unusual symptoms or inexplicable disease. In fact, it may prove difficult to' ever identify the perpetrators or the site of release--or even to determine whether the disease outbreak was intentional or naturally occurring.

The first responders to a bioterroism event would be public health officials and health care workers. Unfortunately, in many scenarios, diagnosis of the problem may be delayed, because medical providers and labs are not equipped to recognize and deal with the disease agents of greatest concern. What is more, effective medical interventions may be limited, and where they exist, the window of opportunity for successful intervention would be narrow. The outbreak is likely to persist over a prolonged period--months to years--because of disease contagion or continuing exposure. The speed of recognition and response to an attack will be pivotal in reducing casualties and controlling disease.

Not only are biological weapons capable of causing extraordinary devastation, but they are relatively easy to produce, inexpensive, and capable of causing significant damage even when small quantities are delivered by simple means. In addition, information about how to obtain and prepare bioweapons is increasingly available through the Internet, the open scientific literature, and other sources. Opportunities for access to dangerous pathogens can be fairly routine; some of these organisms are commonly found in nature or are the subject of legitmate study in government, academic, and industry labs. Furthermore, bioweapons facilities can be hidden within legitimate research laboratories or pharmaceutical manufacturing sites.

Developing a response

Although there are enormous challenges before us, many of the elements of a comprehensive approach are relatively straightforward. …

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